What to Keep in Mind While Choosing a Health Insurance Policy

Today with wellness being paramount and illnesses inevitable, there is a growing significance of health insurance in the lives of all. Whether for an individual safeguarding the health of themselves and their family or a corporation protecting its employees, the right health insurance policy is essential for mitigating financial risks and ensuring continuity. 

The COVID-19 pandemic was a wake-up call emphasising the need for a future-driven risk cover from uncertainties. The lack of health insurance impacted many who faced the wrath of the fatal pandemic. Insurance today is no longer a push product but a pull product. Individuals and businesses alike have recognised the pivotal role of health insurance in securing financial well-being against unforeseen medical expenses leading to a rise in purchases of health insurance policies. Post-COVID the demand for health insurance in India shot up by 321 per cent.

However, the process of purchasing the right insurance policy can be daunting. A recent survey by Local Circle highlighted that 43 per cent of consumers facing problems with health insurance claims.

Things to Keep in Mind

There are multiple aspects that one has to take into consideration, from hospitalisation cover to additional cover available for illnesses, to cover on OPD illness, and extend of the coverage for critical illness. While one takes into account all the aspects that the policy might cover, it is crucial to understand the aspects that the policy excludes.

One must also be careful of what are the sub limits in each of the diseases which are capped. These exclusions and constraints are key aspects that often become the point of concern that leads to rejection of claims. The Local Circle survey also highlighted that some of the major issues faced by policyholders include the lack of full disclosure about exclusions and eligibility for claims in their policies, Ambiguity in contracts due to the use of technical jargon and complex words, and claims rejected due to pre-existing diseases among others. 

To ensure the purchase of the right policy, the insurer must consider having an advisor, a broker, or an intermediary who will help understand the risk potential and offer solutions to effectively manage them. It is imperative to visit the insurance company's website to review statistics such as the number of settled claims, grievances, and rejections, along with the turnaround time for claims settlement. Additionally, before purchasing the policy, one should assess the hospital network affiliated with each insurer. While most hospitals now offer cashless services, it's essential to ensure a smooth admission and discharge process for seamless healthcare experiences. 

The right insurance policy that provides a hassle-free process is also essential to ensure the insured can focus on recovery rather than insurance claim processing. A hassle-free process will also help in making certain that there is no delay in hospital discharge that could lead to minor but additional cost for the patient.  

In case of preexisting diseases, many find it difficult to find the right policy due to the exemption that policies carry. One must explore the many insurance policies which cover preexisting disease after time deductible.  

As per data, nearly 8-12 per cent of the insured submit claims annually. Assessing probability, every 10 years in any given family, there is a chance of a claim being filed. Therefore, one must adequately get the right health insurance cover. Increasing health insurance premiums are also a concern. Given that health insurance companies overall are yet to make underwriting profits, the price will see an upward trend. Hence, buying the right product, which doesn’t hurt the pockets, and which ensures the full settlement of the claim or at least the majority of the claim being settled is key to buying the right kind of insurance product. 

The Insurance Regulatory and Development Authority of India (IRDAI) has been working towards making health insurance accessible to a wide range of individuals in India. By establishing a robust regulatory framework, IRDAI ensures that health insurance products are affordable, transparent, and fair. IRDAI also focuses on consumer protection through stringent guidelines on claim settlements and grievance redressal mechanisms, enhancing trust in health insurance. Inclusive initiatives mandate insurers to cater to various segments, including senior citizens and low-income groups, while digitisation efforts improve access in remote areas.  

In conclusion, health insurance isn't just another expense; it's an investment in your future well-being. By choosing the right policy and understanding its intricacies, you safeguard yourself and your loved ones against unforeseen medical expenses. Remember, informed decisions today pave the way for a secure tomorrow. 

(Views expressed here are personal. Author is CEO and Country Head, Lockton, India)